Comparison of Two Gastric Band (GB) Adjustment Stratigies: Intraopertive Calibration Using the Endoluminal Functional Lumen Imaging Probe (EndoFlip) Plus Monthly Follow Up vs. No Intraoperative Adjustment with Monthly Follow Up in the 1st Year

Ashraf Haddad, MD, Murad Bani Hani, MD, Dominic Nelson, MS, Andrew Averbach, MD, FACS

St Agnes Hospital

Introduction:
The majority of surgeons avoid gastric band (GB) adjustment at placement due to the increased risk of early obstruction. The first adjustment is usually done at 4-6 weeks after surgery. Intensity of follow-up during the first year has been shown to improve weight loss. The EndoFlip catheter allows for safe GB calibration intraoperatively. This study was aimed at comparing two adjustment strategies: monthly follow-up with or without intraoperative adjustment.

Methods:
Two consecutive cohorts, of fifty patients each, who underwent GB placement (Lap Band APS or APL) in 2010-2012 were included in the study. The first cohort had no intraoperative adjustment and was followed monthly (controls). From March 2011 to April 2012 all patients had GB adjustment during the procedure and followed monthly (study group). The EndoFLIP system was used to calibrate the stoma size to an average diameter of 5.2 ± 4 mm. Data analysis included patients demographics, preoperative weight , body mass index (BMI), time to first adjustment, total number of adjustments and visits, and the percentage of excess body weight loss (%EBWL) during the first year.

Results:
The patients’ characteristics of both the study and control groups were similar with a preoperative weight and BMI of 269 ± 44 lb and 43.7 ± 5.7 versus 273 ± 35 lb and 43.8 ± 5.2 respectively. The average follow-up time was 10.2 months for the control group and 7.3 months for the study group (p=0.05). For the control group the percentage of follow up at 3, 6, and 12 months was 67%, 86%, and 75 % respectively and 64%, 78%, and 79% respectively for the study group. At 2 weeks, 4 weeks, 2 and 3 months % EBWL was 12.8%, 17.3%, 22.1% and 24% in the study group versus 12.8, 16.3 %, 20.1 and 22.9% in the control group, respectively. At 6 months and 1 year there was an apparent trend towards higher %EBWL in the study group (34.3% and 48.4%,respectively compared to control – 29.8% and 40.1% ; p value = 0.08 and 0.09 respectively). The mean decrease in BMI at 1 year was 9.4 in the study group versus 7.6 in the control (p value = 0.06).
There was no significant difference in the time to first adjustment, total number of adjustments, or total number of office visits between the two groups.

Conclusion(s):
Combination of intraoperative adjustment with monthly follow-up in the first year appears to facilitate higher weight loss compared to the no intraoperative adjustment strategy although the difference did not reach statistical significance.


Session: Poster Presentation

Program Number: P414

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